Schema therapy: characteristics, functioning and phases.

A summary of the characteristics of schema therapy and its mode of use in patients.

In the clinic there are many cases in which approaching the patient's problems from a single perspective is not very effective. Human reality is very complex, and so are its psychological problems, which pose a challenge if they are approached from a single point of view.

Schema therapy is a therapeutic proposal that was born as an integrative approach of several psychological currents and tools to of several psychological currents and tools in order to improve the quality of the patient taking an eclectic vision of the therapeutic process and how to manage it.

This therapy, proposed by Dr. Young, has been especially useful for personality disorders, but it seems to be valid for many other mental disorders, and below we will discover what they are and what tools it uses.

What is Schema Therapy?

A fact that every clinical psychologist knows is that clinical practice is not as simple as one might expect. The causes behind the patient's psychological distress and dysfunctionality can be various: the patient's own personality, his or her relapse rate, and even the disorder itself.

An example of this are personality disorders (borderline, histrionic, schizotypal...) which are a real challenge for any psychotherapist. In these cases, integrative approaches, such as schema therapy, are the most appropriate..

Schema-focused therapy is the result of a great effort to integrate in a coherent way several therapeutic strategies, coming from different psychological currents focused on the treatment of various psychological problems, especially personality disorders.

Its creator is Jeffrey E. Young, who brought together cognitive, behavioral, constructivist, psychodynamic and experiential models, with special emphasis on childhood.and with special emphasis on the individual's childhood. This therapy is considered to be very effective for chronic psychological disorders or when they do not respond to other therapies.

The main premise of this therapy is to consider that there are some behavioral and emotional patterns that have behavioral and emotional patterns that have their origins in the first years of life, which condition the way in which we live.which condition the way the individual acts and thinks. Schema therapy is very useful to face several of the most difficult problems to deal with in therapy, especially to bring out the patient's inner world, isolate an interpersonal conflict that may be significant in his or her life, disinterest in therapy and the uncooperative attitude that some patients show.

This therapeutic option prioritizes the creation of a strong patient-therapist bond, which will help the practitionerThis will help the professional to get the patient to confront his or her own contradictions through sessions that address what he or she experienced in childhood and what impact it has on his or her current life.

It is a somewhat long therapy, with a minimum duration of one year in which the therapist must show a non-directive attitude, promoting the patient's assessment and discovery of what happens to him, happened to him or could happen to him.

Key ideas and proposals of this psychological therapy.

Mainly, there are two fundamental concepts of this therapy. The first has to do directly with what gives its name to this therapeutic approach, the schemas, while the second has to do with the way in which people maintain or overcome these schemas.

Specifically, Young coined the term "early dysfunctional schemas".This idea is discussed in more detail below.

Early dysfunctional schema

Early dysfunctional schemas are the stable themes that develop over time. that develop over the course of our lives and that come to be perceived very often as if they were true.. Because of this, they have a high resistance to any type of logical argument that tries to unseat them and, in addition, they perpetuate themselves through the person's daily habits and habitual way of thinking.

Schemas have a powerful capacity to condition emotional life, so that if their content is negative, they can be notoriously detrimental to the mental health of the person who presents them. According to the model, these schemas are the result of some kind of dissatisfaction of some infantile need, associated with the following aspectsassociated with the following aspects:

• Insecure attachment: connection with bonding figures.
• Autonomy: development of initiative to explore the environment without fear.
• Expressive freedom: capacity to manifest individuality and will.
• Symbolic play: establishment of positive bonds with the peer group.
• Self-control: inhibition of impulses

The origin of the deficiencies is to be found in the family.but it does not necessarily have to come from her alone.

Young identified as many as 18 schemas of a negative and pathological nature. Frustration of basic needs, abuse and identification with dysfunctional parental patterns would be behind their appearance. would be behind their appearance. Briefly mentioning them, they are:

• Abandonment and instability
• Mistrust and abuse
• Emotional loss
• Imperfection and shame
• Social isolation and alienation
• Dependency and incompetence
• Susceptibility to harm or illness
• Immature identity
• Failure
• Entitlement and grandiosity
• Insufficient self-control
• Subjugation (keeping one's individuality in the background)
• Self-sacrifice
• Approval seeking
• Pessimism
• Emotional inhibition
• Hypercriticism
• Condemnation

Schema operations

From the schema therapy model it is assumed that the patient has one or more of these schemas, which will lead him/her to perform a series of behaviors and thoughts aimed at perpetuating or overcoming them. and thoughts aimed at perpetuating or overcoming them. The pathological perpetuation of these schemas would be carried out by means of four main mechanisms:

1. Cognitive distortions.

They are interpretations of reality that are not at all objective.. Being totally biased interpretations of reality, the behaviors associated with them are not adaptive.

2. Life patterns

The life patterns associated with dysfunctional schemas are unconscious choices of decisions that maintain the situation or do not facilitate options for change and self-improvement. and self-improvement.

3. Avoidance

Avoidance is carried out in the form of flight or escape from life experiences seen as uncomfortable.The company's activities can be a real opportunity for transformation for the better.

4. Overcompensation

Overcompensation consists of the imposition of very rigid patterns of thought and action aimed at showing the opposite aimed at showing the opposite of what is known to be a deficiency.

The aim of the treatment is to mobilize all available resources to enable the patient to adopt and carry out the second of the strategies, i.e. to overcome the harmful patterns in his mind. To this end, a Wide range of therapeutic procedures is offered.

The patient's improvement is achieved through the overcoming of his dysfunctional schemas.. For this purpose, a process aimed at questioning and debating schemes is carried out, in order to get rid of their influence and reduce or annul their effects.

This is the main objective of the therapy and, to achieve it, we try to promote memories, behaviors, emotions and potentially pleasurable and beneficial sensations, a task for which the author selected a varied set of different strategies from practically all the psychological currents that we will see below.

For which patients is Schema-Centered Therapy useful?

Schema-focused therapy is especially useful for all those patients who present with a disorder for all those patients who present a disorder located in the Axis I of the DSM-V.. Among these clinical conditions we would find:

• Anxiety disorders
• Mood disorders
• Dissociative disorders
• Personality disorders

Jeffrey Young himself pointed out that schema-focused therapy is beneficial for all those people who cannot easily talk about their emotions, thoughts and feelings.. This approach is useful for those cases in which patients suffer from some kind of blockage or refusal to express their inner world. Patients with existential crises or even with low motivation to the therapy itself are also benefited.

Phases of this therapy

The therapeutic process within schema therapy is divided into three phases is divided into three phases.

1. Evaluation and psychoeducation

The first stage of the therapy is focused on establishing and stimulating the quality of the therapeutic relationship and on inquiring about past experiences with the intention of identify the schemas that have conditioned the subject's life and to know how they have compromised his life up to the present time.

It is necessary for the patient to review his or her own history, something that is not easy, but fortunately there is also a part of reading materials and completing questionnaires with which the variables of psychological interest are explored, such as attachment style or emotional regulation.

It is at this point that the objectives of the program are set and the therapist chooses the most appropriate tools to address the specific case.

2. Therapeutic change phase

In the change phase, the therapeutic procedures to treat the case begin to be applied. The format of administration is individual, but if circumstances require it, sessions with the family or even with the couple can be scheduled.. The main techniques used in this phase are:

Cognitive techniques 2.1.

The aim of the cognitive techniques used in schema therapy is to review the evidence for and against which the person has available to maintain or eliminate a certain belief..

The mental health professional asks the patient open-ended questions that are not intended to persuade the patient, but to contrast the patient's hypotheses, which is called guided discovery.

Strategies such as counter-arguments or the use of cards with rational ideas are also used. the use of cards with the rational ideas that have been derived from this discussion process.. These cards are especially useful since the patient can carry them with him to read them when necessary.

2.2. Experiential techniques

Experiential techniques aim to deal with the schema from the emotional and existential point of view. To do so, they use a series of strategies such as imagination (evoking past experiences with the guidance of the therapist), role-playing (patient and therapist play important roles in the patient's life) or the empty chair.

This last technique is of particular importance. The empty chair consists of placing two unoccupied seats, facing each other, with which the patient will act out a conversation between himself and a significant person in his life, such as a father, a brother, an uncle... The idea is that he will play the two roles alternately, sitting in one seat as himself and in the other as the other person, having a conversation related to the topic to be addressed in therapy.

2.3. Behavioral techniques

Behavioral techniques aim to identify situations in which the individual may behave in a dysfunctional and maladaptive way for him/herself and others, considering what changes should be made to respect such behavior and environment.The aim is to identify situations in which the individual may behave in a dysfunctional and maladaptive way for him/herself and others, meditating on what changes should be made with respect to such behavior and environment.

They also seek to strengthen useful strategies for solving important problems for the patient, thus increasing his or her sense of self-efficacy.

3. Completion of therapy

The duration of a schema therapy program can be very variable, although as a general rule it is as a general rule, it lasts longer than other similar approaches..

The aim is to detect and modify the totality of maladaptive schemas and behaviors, and therapeutic success is considered to be achieved when the patient manages to live a life with greater affective autonomy.

Often, once the process has been completed, it is also considered to be successful when the patient manages to live a life with greater affective autonomy. a series of follow-up sessions are scheduled to assess the maintenance of improvements in the patient's life..